Les supplémentations nutritionnelles en acides gras polyinsaturés dans le traitement de la neuropathie diabétique périphérique

Abstract

Linoleic and α-linolenic acids, the two essential fatty acids, are the precursors of the n-6 and n-3 PUFA family, respectively. Those PUFA play a strong regulatory function on cells via their incorporation into the membrane phospholipids, and also on the microcirculation by the way of the eicosanoids production. Diabetes mellitus induces a decrease in PUFA biosynthesis due to an inhibition of desaturases, enzymes involved in their synthesis. The decrease in the PUFA bioavailability will conduct to markedly alterations in the membranes and in the microcirculation. Those metabolic perturbations are involved in part in the degenerative complications of diabetes such as the neuropathy. Nutritional supplementations with PUFA have given very interesting results in experimental diabetic neuropathy but also in the case of human diabetic neuropathy. In the n-6 family, the γ-linolenic and arachidonic acids allow to prevent the physiological abnormalities associated to the neuropathy. The results obtained with the n-3 family PUFA are more discordant, probably because of the simultaneous use of eicosapentaenoic and docosahexaenoic acids. Indeed, eicosapentaenoic acid could have a deleterious effect induced by competition with arachidonic acid, a fatty acid whose the concentration is already reduced in diabetes. Nevertheless, the use of phospholipids enriched in docosahexaenoic acid has allowed to obtain positive results in the treatment of the experimental diabetic neuropathy. The use of purified fatty acids, brought as different forms, can open a new area for treatment of clinical diabetic neuropathy.